No consent given for fluoridation

Peer-reviewed studies show fluoride does cause adverse health effects, write anti-fluoride campaigner and Dunedin psychiatrist Bruce Spittle and Dunedin dentist Russel McLean.

Informed consent was not discussed by the 21 staff from the Otago School of Dentistry in their recent letter to the Dunedin city councillors (ODT, 21.8.13).

They described community water fluoridation as the adjustment of fluoride levels up or down to an optimal level for the prevention of tooth decay.

However, under section 4a of the Medicines Act 1981 the prevention of disease is a therapeutic purpose and under section 3 (1a) a substance administered to human beings for a therapeutic purpose is a medicine.

Under right 7 of the Health & Disability Commissioner's Code of Health and Disability Services Consumers' Rights Regulation 1996, services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent.

Community water fluoridation in Dunedin can be considered to constitute medical treatment because sodium silicofluoride is added to the drinking water to increase the concentration of fluoride ions for the therapeutic purpose of preventing dental caries in the population.

The target level of 0.75ppm of fluoride has been chosen to promote mineralisation of tooth enamel while minimising toxic side-effects such as dental fluorosis.

Adding fluoride to water differs from adding iodine to salt or folic acid to bread because fluoride is not a nutrient, no physiological reaction in the human body requires fluoride, and fluoride is not required for any aspect of human growth, development or reproduction.

The use of fluoride in water fluoridation is similar to the use as medicines of other non-essential substances such as the salts of various elements, including antimony, arsenic, bromide, gold, lithium and mercury. Treating a patient with any of these requires that patient's consent.

To ethically justify treating whole populations without their consent, stringent conditions must be met with the treatment being clearly effective, the benefits conferred being greater than the harms caused, the treatment being necessary, the treatment infringing on individuals as little as possible and the treatment being publicly justifiable.

A recent review (Public Health Ethics) found there was insufficient ethical justification of artificial water fluoridation in Australia.

Three peer-reviewed papers describing adverse health effects from fluoride are:

(i) R. Carton reviewed the 2006 United States National Research Council report, ''Fluoride in drinking water'', and found water fluoridation caused dental fluorosis, stage I skeletal fluorosis with arthritis, decreased thyroid function particularly in individuals with inadequate dietary iodine intake, and adverse effects on the brain.

(ii) P. Grandjean found fluoride caused neurotoxicity with lowered IQ, including in children in a low iodine area with 0.88ppm of fluoride in their drinking water.

(iii) E. B. Bassin found that 6- to 8-year-old boys using fluoridated water had a higher rate of the bone cancer osteosarcoma before the age of 20. The efficacy of water fluoridation is modest.The Dental School staff referred to the 2009 New Zealand Oral Health Survey which noted that in 2008, for all of New Zealand, the 5-year-olds in fluoridated areas had a percentage caries-free rate of 58.7% compared to the rate of 55.0% for those in non-fluoridated areas. However, the 2011 figures show little difference, with the rate for fluoridated areas being 59.91% and that for non-fluoridated areas being 59.18%.

Medical treatments require informed consent, the adjustment of the dose to the needs of the individual and their response to treatment, and stopping the treatment if side-effects occur.

Although the level of fluoride in water can be controlled, the dose consumed by an individual cannot be, as it varies with the amount of water consumed.

As fluoride acts topically on teeth rather than systemically, applying fluoridated toothpaste is a more rational way of delivering fluoride to the teeth and avoids the ethical difficulties of water fluoridation.

The sensible public health decision is to discontinue water fluoridation in our city.



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